The Use of Screening Tools for Cardiovascular Risk Assessment in Psoriasis - A Case- Control Study

Background: Psoriasis is a common, T-cell-mediated disease, affecting 0.44-2.8% of the general population in India. It is associated with a higher risk of cardiovascular disease possibly due to chronic inflammation. Those patients with severe psoriasis are at a higher risk of death due to cardiovascular disease. The use of scoring tools may help the care providers to assess cardiovascular risks in these patients. Aims: The aim of this study was to assess the cardiovascular risks in patients with severe psoriasis using the commonly used risk-assessment tools (Framingham risk score [FRS] and Pooled cohort equations [PCE]) and to understand the utility of these tools in practice. Methods: It is a case-control study performed in the dermatology outpatient department of a tertiary care center during the study period from January to December 2020. Consenting adults with chronic plaque psoriasis and psoriasis area and severity index (PASI) more than 10 were included in the study. The FRS and PCE risk scores were calculated for the patients and age- and sex-matched healthy controls. Results: A total of 213 patients were assessed and 30 patients were excluded. Of the 183 patients, 152 patients were assessed using FRS and 135 patients using PCE. Equal number of age- and sex-matched healthy controls were also assessed. The mean age of the patients assessed using the FRS and PCE was 47 +/- 10.9 and 52.84 +/- 8.9 years, respectively. The mean age of the controls was 45.52 +/- 8.7 and 51.76 +/- 8.1 years in the FRS and PCE groups, respectively. The male to female ratio was 1.92:1 and 2:1 in the FRS and PCE risk-score groups, respectively. The mean PASI score was 16.45 +/- 7.88 and 15.6 +/- 7.6 in the two groups, respectively. The 10-year risk estimate using FRS in the patients ranged from 0 to 26.9%. The mean and median estimates were 4.95 +/- 5.7 and 2.8%, respectively, while 2.65 +/- 4.7 and 0.8% in the controls (P = 0.001). The 10-year risk estimate in the patients using the PCE risk score ranged from 0.3 to 39.6%. The mean and median estimate in the patients was 8.17 +/- 9.9 and 5.2%, respectively while they were 5.68 +/- 7.5% and 2.6% in the controls (P = 0.024). The agreement between the FRS and PCE was found to be poor (K, 0.049). There was no statistically significant correlation of PASI to either the PCE risk score (P = 0.498) or FRS (P = 0.630). Limitations: A small sample size, and study in a tertiary care center may have resulted in sampling bias. Conclusion: Psoriasis is associated with a higher risk of cardiovascular disease. These tools may help a dermatologist in the primary prevention of cardiovascular disease. It can also help in the awareness of the increased risk of cardiovascular disease in patients.